| Research has shown the implantable cardioverter defibrillator (ICD) may be associated with psychosocial complications and reduced quality of life. However, few studies have prospectively examined patient characteristics as predictors of outcome post-implant. The major objectives of the current study were (1) to obtain descriptive information regarding pre-implant psychological functioning, experience of ICD firings, and post-implant quality of life, and (2) to examine the association between pre-implant psychological patient characteristics, experience of ICD firings, and post-implant quality of life ratings. This study prospectively assessed 88 first-time implanted ICD patients, and included both short and long-term follow-up assessments (8 & 14 months, respectively). Pre-implant psychological functioning was within normal limits for the ICD study sample, whereas post-implant quality of life was mild to moderately impaired across all indices. Approximately half of the sample reported experience of ICD firings at each follow-up. Separate hierarchical regression analyses were conducted to examine the degree of association between the predictor variables (history of depression, trait anxiety, dispositional optimism, perceived social support, and ICD firings) and each of the four dependent variables (mental health, general health, physical limitations, and disease perception quality of life ratings). All analyses controlled for initial assessment patient age and ejection fraction. The proposed model accounted for a significant proportion of the variance observed in patient quality of life ratings for mental health, general health, and physical limitations at both follow-up intervals (variance accounted for ranged from 41.7% to 64.5% depending upon outcome assessed). Further, the proportion of variance accounted for by the psychological variables was equal to or larger than the variance accounted for by the control variables. To a lesser degree, experience of ICD firings significantly added to each model. Exploratory ANOVAs were conducted and ICD patients with lower levels of dispositional optimism had significantly lower quality of life ratings in all areas assessed at both follow-up intervals. Additionally, patients with higher levels of trait anxiety had significantly lower quality of life ratings in all areas assessed at the long-term follow-up interval. This data set emphasizes the importance of a biopsychosocial model in understanding quality of life outcomes for ICD patients. |
